The applicant, Gareth Dulai, is a Clinical Instructor in Digestive Diseases at the University of California Los Angeles (UCLA) who seeks financial support for a program of mentored, patient-oriented clinical research and concurrent multidisciplinary didactic training in the methods of clinical investigation. If given the support necessary to sustain this period of training, the applicant has the personal drive and institutional resources needed to become a successful, independent clinical investigator. His specific area of interest lies in developing means to assess and improve the quality of healthcare provided to patients with Barrett' esophagus (BE) - a common, chronic, costly, and clinically significant pre- cancerous disorder in the United States' population. In order to achieve his academic goals, the applicant and his experienced mentor (Dr. Dennis M. Jensen) have designed a three-phase career development plan. This plan is consistent with the applicant's goals and his previous research experience. Strengths of this plan include the high-level of research and educational support available at UCLA and its General Clinical Research Center (GCRC). The initial phase consists of didactic work in UCLA's School of Public Health. The second phase, overlapping with the first, consists of a series of three studies involving subjects with BE utilizing UCLA's GCRC. The specific aim of the first study - a cohort study of dysplasia and risk of neoplastic progression in BE - is to estimate the magnitude of cancer risk in BE cases according to baseline dysplasia status. The specific aims of the second study - patient derived utility valuations of health states in BE - are to identify, characterize, and weight health states in BE using patient preferences. The specific aims of the third study - a randomized prospective clinical trial of ablation therapy for BE - are to evaluate the relative efficacy, safety, cost, and effect on health related quality of life of two types of novel therapeutic interventions for the removal of BE. The unifying objective of these research projects is to develop rational, cost-effective strategies for cancer prevention and control in patients with BE. The NCRR's K23 Award will provide the salary support necessary to allow the applicant to successfully complete this critical period of mentored study and patient- oriented research. During the third phase of his career development plan, the applicant will use the knowledge, skills, and research base acquired to compete for subsequent independent research support from the National Institutes of Health, Veterans Administration, and other funding agencies. The applicant has no comparable source of salary for the proposed period of research and training.